Reply to Blatt and Fonagy

I would like to thank JAPA for inviting Sidney Blatt and Peter Fonagy to comment on our paper and for publishing the ensuing dialogue. It is indeed a special opportunity to have such luminaries in the field reflect openly on our work. We had an ambitious agenda for our target paper and recognize that we may not have been able to accomplish all of our missions simultaneously. Like Sidney Blatt, we hope that many readers may wish to learn more about the methods we describe in our two studies. For more information about the 100 items that constitute the Psychotherapy Process Q-set (PQS), I suggest reading Enrico Jones's exceptional book, Therapeutic Action (2000), which provides an excellent conceptual overview of the measure and contains its complete coding manual and 100 items. Blatt was also curious about the similarities and differences between our prototypes of analytic process and cognitive-behavioral process. For a thorough comparison of the prototypes, please see Ablon and Jones (1998), as that was indeed beyond the scope of this paper.

As Peter Fonagy points out, psychotherapy researchers face a daunting task trying to capture the tremendous depth of clinical encounters in a manner that can be subjected to quantitative analysis. For this reason, any empirical research into the process of psychoanalysis is an easy target for criticisms of superficiality and lack of depth. Psychoanalysis will suffer, though, if such criticisms deter researchers from at least attempting to capture complex phenomena in reliable empirical ways. The lack of an empirical (here I mean quantitative) foundation in psychoanalysis has left the field open to attack in an age in which clinicians, patients, and third-party payers all have heard about “empirically supported” treatments. Perhaps the most worrisome aspect of the empirically supported treatment movement is that many training programs in the United States today teach only treatment processes that have received empirical support in